臨床診斷學(xué)課程習(xí)題

選擇題（中文A.第四胸椎下緣B.氣管分叉C.心房下緣D. A.矮胖體型者B.肺氣腫C.D.A.腦B.酮癥酸C.尿毒癥酸D.神經(jīng)衰A.肺氣腫B.大量胸腔積液C.性肺不張D.胸壁皮下氣A.肺氣腫B.肺不張C.隔肌麻痹D.肺尖部結(jié)核A.大葉性B.空洞性肺結(jié)核C.性肺不張D.支氣管 B.氣管向患側(cè)移位C.患側(cè)叩診呈濁音D.患側(cè)語音增多選題（中文（AA.B.C.肺下界降低D.（ABCDA.慢性支氣管炎B.支氣管哮喘C.心源性哮喘D.A.喉部B.背部第1，2胸椎附 C.胸骨兩側(cè)第1，2肋間D.右肺肺泡呼吸音的特點(diǎn)是（ACA.柔和吹風(fēng)樣B.吸氣音比呼氣音弱C.音調(diào)較高時間較長D.ha左側(cè)胸痛可見于下列哪些疾?。ˋBCD急性胰腺炎B.肺癌C.急性冠脈綜合癥D.問答題（中文答：吸氣性呼吸特點(diǎn),吸氣費(fèi)力，顯著時出現(xiàn)三凹癥，常伴干咳與高調(diào)吸氣性喉鳴，提答視診喜患側(cè)位，患側(cè)胸廓飽滿，肋間隙增寬，呼吸運(yùn)動受限，心尖搏健側(cè)移位。觸診氣管移向健側(cè)，患側(cè)呼吸運(yùn)動減弱，語音振顫減弱或。聽診積液區(qū)呼吸音減弱或語音減弱或積液上方可聞及減弱的支氣管答由于氣管.支管或細(xì)支管狹窄或分阻塞,吸入或呼出時生湍流所生特點(diǎn)：持續(xù)時間較長,吸氣及呼氣時均可聽及，以呼氣時為明顯。干羅音的強(qiáng)度和性質(zhì)易改答1）胸膜炎癥如結(jié)核性胸膜炎WhichoneisnottrueforsternalItisalsotermedLouisItisformedbytheprotrusionoftheconjunctioncomposedofsternumandmanabriumsterni.Itactsasanimportantlandmarkforcountingrib(paralleltothirdrib)andItindicatesthebifurcationofthetrachea,theupperleveloftheatriaofheart,thedemarcationofupperandlowerpartofmediastinum,andthefifththoracicvertebraasThedepressedregionabovetheclavicle,whichcorrespondstotheupperpartofeachlungapex,iscalled( A.Suprasternalfossa B.Supraclavicularfossa C.InfraclavicularfossaD.SuprascapularregionBarrelchestisoftenseenin C.chronichecticdisease D.p KEY:(B)Subcutaneousemphysemaatchestiscommonlyduetothefollowing injuriesofinjuriesofinjuresoflocalinfectionofbacillusaerogenesKEY:(D)Deepslowbreathing(Kussmaul’srespiration)istypicalof( KEY:(B)Tachypneaindicatestheincreasedrespiratoryrate,over )per KEY:(C)WhichofthefollowingiswrongforthelowerboundaryoftheanteriorpartwhichbeginsfromthesixthatthelevelofthesixthinterspacealongthemidclavicuarattheleveloftheeighthinterspacealongthemidaxillarytheposteriorpartofthelowerboundarythatapproacheshorizontallineattheninthriblevelbytheinferioranglelineWhichofthefollowingisA.Tidalbreathingisalsocalledcheyne-stokesCheyne-stokesrespirationwaxesandwanescyclicallysothatperiodsofdeepbreathingalternatewithperiodsofapnea(nobreathing).Ataxicbreathingischaracterizedbyunpredictableirregularity.Breathsmaybeshallowordeep,andstopforshortperiods.Ataxicbreathingislessseverethanthetidalbreathing.KEY:(D)Fremitusisdecreasedorabsentinthefollowingconditions obstructedbronchusorchronicobstructivepulmonarypleural Hyperresonancecanbeheardduringthepercussionof A. B.C..tuberculosis D.pleuraleffusionKEY:(B)WhichoneisnottrueforbronchialBronchialbreathsoundsareingeneralhigherinpitchthanvesicularorbronchovesicularsounds.ExpirationusuallysurpassesinspirationinBronchialbreathingisnormallyheardovertheItoccursonlywithpulmonaryconsolidation.KEY:(C)Theincreaseofvesicularbreathsoundsmayindicate A.pleuralfluid C.foreignbodyintrachea D.p KEY:(B)Oneofthemostcommoncausesofdecreasedorabsentbreathsoundsis fluidinthepleuralcompletebronchialobstructionKEY:(B)WhichofthefollowingcharacteristicisincorrectformoistItisformedbecauseoftherepresentstrictureorpartialobstructionofthetrachea,bronchiorbronchioles,ItisformedduetothepassageofairthroughthinsecretionsintherespiratoryItcanbecausedbyexudate,sputum,blood,mucus,orThesoundmaydiminishaftercough.KEY:(A)Howtodescribethemassofbreastintermsofpalpation①Location:Theexactlocationofthemassmustbedesignated.Generalmethodistotakethenippleasthecentralpoint,describethemassaccordingtotheclocknumbersandaxis.Furthermore,thedistanceofthemassfromthenipplemustberecordedforthesakeofaccuratelocationofthemass.②Size:Themassmustbedescribedinlength,widthandthickness,forthecomparisoninthefuturetodetermineifitprogressesorregresses.③Contour:payattentiontowhetherthemassisregularorirregular,themarginisdulloracute,andwhetheritadherestosurrondingtissueornot.Mostbenigntumorshaveasmooth,regularcontour,whereasmostmalignantmassesareconvavoconvex,withfirmedmargin.However,itmustbementionedthatinfltorylesionsmayalsohaveanirregularcontour.④Consistency:Thehardnessmustbedescribedclearly.Itmaybedescribedgenerallyassoft,cystic,moderayfirmorextremelyhard.Abenigntumorisusuallyfeltsoft,cystic;whileafirmconsistencymasswithirregularcontourusuallydenotesamalignantlesion.However,ahardregionmayalsobecausedbyinfltion.⑤Tenderness:Itshouldbeascertainedwhetherornotthelesionistender,and,ifso,towhatdegree.Aninfltoryprocessisusuallymoderayormarkedlytender,whereasmostmalignantlesionsarenotobviouslytender.⑥Mobility:Theexaminershoulddeterminewhetherthelesionislymovable.Ifitismovableincertaindirections,orfixed,hemustdeterminewetherthemassisfixedtotheskin,tothedeepstructures,ortothesurroundingbreasttissue.Mostbenignlesionshavealargemobility,infltorylesionisconsiderablyfixed,andamalignantlesioninearlystageismovable,however,astheprocessdevelopes,esfixedbecauseotherstructuresarePleasedescribetheetiologyandcharacteristicsofmoistralesandMoistrale:producedduetopassageofairthroughthinsecretionsintherespiratorytract,suchasexudate,sputum,blood,mucus,orpusetc.Thesoundcouldalsoberegasdedascracklesproducedbyreopeningofthebronchialsatinspirationwhenbronchiolarwalladheresandclosesbecauseoftenacioussecretionatexpiration.Characteristicsofmoistrales:adventioussoundsbesidesbreathsound,discreteandshortintime,oftenseriesofjeveralsoundsappear,siginificantininspirationorintheterminalphaseofinspiration,presentsometimesintheearlyphaseofexpiration,thelocationisratherfixed,qualitynotvariable,mediumandfineralecouldbepresentsimultaneously,itmaydiminishordisappearaftercough.Rhonchi:producedbecausetherepresentstrictureorpartialobstructionofthetrachea,bronchiorbronchioles,airthroughthesepassways esturbulent,thepathologicbasisforwhichisinfltorymembranouscongestionandedemaoversecretion,bronchialmuscularspasm,obstructionduetotumorandforeignbodiesinthebronchiallumen,andstrictureduetooppressianofextraluminalenlargedlymphnodesormediastinaltumors.Characteristicsofrhonchi:theyarecontinuous,relativelylong,andmusicaladventiousbreathsound.Rhochiareratherhigh-pitchedwiththebasicfrequencyofabout300-500Hz.Audiblebothduringinspirationandexpiration,ingeneralmoreprominentduringexpiration.Rhonchiareeasilyvariableinintensity,qualityandlocation,sometimestheychangeobviouslyinstantly.Trytomakedifferentialdiagnosesamongconsolidationoflungdisease,emphysema,aeis,pleuraldiffusionandpothorax

ledononededabothbothADentingDisappearedtheedonedtFullnessDiminishedtheededshedtancedDentingtheedontFullnessDiminishedtheedshedtanced 第五肋間,0.5~1.0cmC.第五肋間,0.5~1.0cm 劍突下搏動意味著肥 摩擦感表示已無積 3／6 S1 Austin-FlintDuroziez 2-55-1010-1515-2020mmHg 問答題（中文鑒別 器質(zhì)性雜 部位肺動脈瓣區(qū)、心尖 小于等于2/6級 常大于等于3/6級 3/6級以上可伴有 收縮壓舒張壓1級高血壓（度2級高血壓（度3級高血壓（度周圍血管征是指由于脈壓增大而導(dǎo)致周圍動脈和毛細(xì)血管搏動增強(qiáng)的一組體征沖（AustinFlint雜音DuroziezThebestwaytomakedistinctionbetweenpleuralfrictionsoundandpericardialfrictionsoundis( A.soundtiming soundquality C.soundrelationwithrespiration WhichoneisnottrueforgallopItisthepathologiccounterpartoftheS3andoccursatthetimeofrapiddiastolicventricularfilling.Itisabrieflow-pitchedItoccursatmiddlediastoleattheendofrapidfillingphaseofItreflexesthattheRVfunctionisdecreased.KEY:(D)Continuousmurmurcanbeheardin MitralMitralAorticPatentDuctusArteriosusKEY:(D)HowtodifferentiatebetweenS1and apex pitch,lastingtime pitchlastingtime S1 ApicalDescribethecharacteristicsofatrialfibrillationintermsofTheventricularrhythmhas ynoTheintensityofS1isTherateofheartandpulseareExinthetermauscultatoryvalvel.Mitralvalvearea:itisattheapex,inthefifthleftintercostalspace,medialtothemidclavicularline.Aorticvalvearea:therearetwoauscultatoryareaofAV,oneislocatedinthesecondrightintercostalspace,justlaltothesternum.Theotherisatthethirdorfouthintercostalspace,lefttothesternumborder.WecallitthesecondauscultatoryareaofPulmonaryvalvearea:inthesecondintercostalspacejust ltotheTricuspidvalvearea:atthelowerpartofthesternalnearthe.Thephysicianshouldadoptasystematicwayoflistening:startattheapex,thenmovetothePVarea,AVarea,secondAVarea,TVarea.PleasedescribethesignsofMitralInspection:“MitralFacies”maybepresent.TheapicalpulsemayextendtoleftPalpation:diastolicthrillmaybefeltatPercussion:Thecardiacdullnessextendtoleftinearlystageandlatertoright.Thecardiacsilhouetteislikeapear.Auscultation:Aloudsnappyfirstsoundandalocalizedrumblingdiastolicmurmurinthemid-latestagemaybeheardatapex.Theopeningsnapmaybepresent.Thepulmonarysecondsoundmaybeaccentuatedofsplitting.Doyouknowthemechanismsofheartl).IncreasedvelocityofbloodflowthoughnormalForwardflowthoughnarrowedordeformedBackwardorregurgitantflow petentAbnormalVibrationofloosestructurewithintheIncreasewithdiameterofamajorTrytomakedistinctionbetweenfunctionalmurmurandorganicanyageapexorpulmonaryvalveanylong,inallsystolicnotlong,transmittedwiththedirectionofParadoxicalpulsecanbeenfoundin A.constrictivepericarditis D.anemiaKEY:(A)11.Couldlusthedefinitionsclassificationsofbloodpressure130-85-IsolatedThemostimportantsignindicating petenceisDecreaseinintensityofBoot-likeDiastolicmurmursinaorticAustin-flint'smurmursinapicalWaterhammerpulseKEY:(C)Graham-sl'smurmurmeansdiastolicmurmurintheapicalareacausedbystructuralmitraldiastolicmurmurinaorticareacausedby diastolicmurmurinpulmonicareacausedbyrelatively diastolicmurmurinapicalareacausedbyrelativelymitraldiastolicmurmurcausedbyrelativelytricuspidstenosisKEY:(C)Whichsignreferstostructuralheartliftedapexdiscementoftheapicalimpulsetothepercussionofdullnessextended systolicmurmursinapicalwidesplittingofS2inpulmonaryareaKEY:(C)Whichofthefollowingcharacteristiciswrongastoalowerpitchedsoundthanshortereasilyheardatsupineorleft lmoreclearintheareainnerandsuperiortothecardiacmoreclearattheendofinspirationKEY:(E)WhichofthefollowingcharacteristicisnotconsistentwiththeincreaseintheintensityofS1? ventricularprematuremitralLGLatriaandventricleapartnessKEY:(A)WeakermurmurmeanslessFasterthebloodflows,loudertheThegreaterdifferenceofpressurebetweentwobordersofthestenosismakesthemurmurlouder.StrongercontractionmakesmurmurThemostseverestenosisdoesn'tmeantheloudestmurmur.KEY:(A)Whichofthefollowingcharacteristicisnotconsistentwiththetypicaldiastolicmurmurinmitralstenosis?increaseinearlyandmiddiastolicincreaseinlatediastoliclouderintheapex paniedbyS4KEY:(A)WhichofthefollowingcanoccurinleftventricularwaterhammerpulsusdicroticpulsuspulsusparadoxusKEY:(D)WhichisthemosttypicaltestfordiagnosingmitralchestX-increaseinsubcutaneousnotallaboveKEY:(E)LiftedapicalimpulseismostcommonlyseenpulmonicheartrightventricularhyperhypertensionheartnotallmentionedaboveKEY:(E)Inbloodpressuretesting,straitlycu